Annulus repair systems, instruments and techniques

ABSTRACT

Systems and methods for repairing annulus defects include at least one blocking member positionable in or adjacent to the annulus defect, and at least one anchor for securing the blocking member to adjacent tissue recessed into the adjacent vertebrae. The blocking member extends at least partially across the annulus defect for repair of the defect and/or retention of nucleus material, one or more implants, bio-compatible materials or device, and/or other objects positioned in the disc space. Instruments are provided to facilitate preparation of the implantation site of the annulus repair system

BACKGROUND

The present invention relates generally to the field of spinal surgery,and more particularly to systems and techniques for repairing an annulusdefect.

There are various surgical procedures and conditions that create adefect in the annulus fibrosis, such as, for example, an annulotomy, adiscectomy, nucleotomy, implantation of artificial disc nucleus orartificial disc prosthesis, repair of a disc herniation, and annulusdegeneration. Repair of annulus defects is normally perceived as timeconsuming and ineffective. Thus, annulus defects are commonly leftunrepaired. This may lead to a higher incidence of disc herniation orreherniation, or expulsion of the implant from the disc space.

In those procedures where the annulus is repaired via sutures thatattempt to close the defect by pulling the surrounding tissue together,there are difficult challenges encountered. Often, the annulus defect isa relatively large hole that is difficult to close with conventionalsuturing techniques. It can also be difficult to actively engage thesutures in the surrounding annulus tissues, and the sutures could cut ortear through the annulus tissues after the repair has been made.

SUMMARY

The present invention is directed to systems, devices, techniques andmethods for repairing annulus defects. Embodiments of the systems anddevices include at least one blocking member positionable in or adjacentto the annulus defect and attachable to adjacent tissue. Instruments forpreparing the vertebrae for attachment of the blocking member in and/oradjacent to the annulus defect are also provided. The blocking memberextends at least partially across the annulus defect for repair of thedefect and/or retention of nucleus material, one or more implants,bio-compatible materials or devices, and/or other objects positioned inthe disc space.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevation view of one embodiment annulus repair device.

FIG. 2 is an elevation view of one embodiment pair of fasteners forsecuring the device of FIG. 1 to adjacent vertebrae.

FIG. 3 is an elevation view of a spinal column segment with an annulusdefect.

FIG. 4 is a sectional view through the defect of the spinal columnsegment of FIG. 3.

FIG. 5 is an elevation view of the spinal column segment with holesformed in the adjacent vertebrae.

FIG. 6 is a sectional view through the defect of the spinal columnsegment of FIG. 5.

FIG. 7 is an elevation view of the spinal column segment with recessesformed in the adjacent vertebrae in communication with the holes.

FIG. 8 is a sectional view through the defect of the spinal columnsegment of FIG. 7.

FIG. 9 is an elevation view of the spinal column segment with the repairdevice of FIG. 1 secured in the holes and recesses formed in theadjacent vertebrae.

FIG. 10 is a sectional view through the defect of the spinal columnsegment of FIG. 9.

FIG. 11 is an elevation view of another embodiment annulus repairdevice.

FIG. 12 is an elevation view of one embodiment pair of fasteners forsecuring the device of FIG. 11 to adjacent vertebrae.

FIG. 13 is an elevation view of the spinal column segment with holesformed in the adjacent vertebrae.

FIG. 14 is a sectional view through the defect of the spinal columnsegment of FIG. 13.

FIG. 15 is an elevation view of the spinal column segment with recessesformed in the adjacent vertebrae in communication with the holes.

FIG. 16 is a sectional view through the defect of the spinal columnsegment of FIG. 15.

FIG. 17 is an elevation view of the spinal column segment with therepair device of FIG. 11 secured in the holes and recesses formed in theadjacent vertebrae.

FIG. 18 is a sectional view through the defect of the spinal columnsegment of FIG. 17.

FIG. 19 is an elevation view of one embodiment cutting instrument.

FIG. 20 is a plan view of a distal portion of the shaft of theinstrument of FIG. 19.

FIG. 21 is a plan view of a distal portion of a cutting blade comprisinga portion of the instrument of FIG. 19.

FIG. 22 is an elevation view of a drilling instrument.

FIG. 23 is a perspective view on one embodiment guide instrument usablewith the cutting instrument and drilling instruments of FIGS. 19 and 22.

FIG. 24 is an exploded perspective view of a distal portion of the guideinstrument of FIG. 23.

DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

For the purposes of promoting an understanding of the principles of theinvention, reference will now be made to embodiments illustrated in thedrawings and specific language will be used to describe the same. Itwill nevertheless be understood that no limitation of the scope of theinvention is thereby intended. Any such alterations and furthermodifications in the illustrated embodiments, and any such furtherapplications of the principles of the invention as illustrated hereinare contemplated as would normally occur to one skilled in the art towhich the invention relates.

The annulus repair system and methods include a blocking member retainedwithin or adjacent a defect in the annulus fibrosis of a spinal disc.The blocking member can block all or a portion of the defect or voidwithin the annulus fibrosis, such as may be caused by surgery or discherniation. The blocking member is retrained in a substantially fixedposition within the defect or void relative to adjacent soft or hardtissue. The blocking member can include one or more attachment portionsconnectable to or integrally formed with the blocking member. Theattachment portions may be engaged to bone or other tissue adjacent tothe defect or void.

With respect to the various embodiments described herein, the blockingmember is recessed in or positioned within the defect so that it extendssubstantially across the annulus defect. The recessed positioning of theblocking member facilitates placement of the blocking member toward theinner wall of the annulus, and thus adjacent the nucleus and/or implantpositioned in the disc space. The blocking member resists implant and/ornucleus migration into the annulus defect, providing an effectiveblocking mechanism and repair of the annulus defect.

The attachment portions and/or anchors associated with the blockingmember can be recessed within the adjacent bone portions to facilitateattachment of the blocking member in a position within the annulusdefect. Anchor can directly attach the blocking member to adjacenttissue. If provided, the attachment portions can be joined or fixed tothe blocking member using various devices and/or techniques, or can beintegrally formed with or be an extension of the blocking member. Theblocking member can be joined or attached to the attachment portion by,for example, sewing the attachment portion to the blocking member,thermal welding or bonding, adhesive bonding, three dimensional weavingor braiding, screws, staples, pins, tacks, crimps, or rivet fixation,for example. Furthermore, the attachment portion can be secured to theblocking member either before or after the blocking member is placedwithin the annulus defect. It is further contemplated that theattachment portions can be provided in the form of sutures, threads,cables, or wires, for example, that engage the blocking member andsecure the blocking member to anchors engaged to tissue adjacent thedefect.

The blocking member can be provided in various forms. Examples include ablocking member that comprises a suture, tether, mesh, sheet, plug,scaffold or combinations thereof. The blocking member can be fabricatedfrom components that are flexible or exhibit at least some flexibility.Examples of such components include woven fabric tubing, woven andnon-woven mesh, or braided or woven structures, folded woven fabric,tethers, cords, planar members, bands, wires, cables, or any othercomponent capable of extending across an annulus defect. Additionally,the blocking member may be resilient and/or elastic so it can assumevarious shapes during and after insertion and attachment. Growth factorsor cells can be incorporated into the blocking member to accelerate theannulus repair process. Growth factors can be transforming growth factorβ1, insulin-like growth factor 1, platelet-derived growth factor,fibroblast growth factor, bone morphogenetic protein (BMP), LIMmineralization protein (LMP) and combinations thereof.

The blocking member can be made from any biocompatible material,material of synthetic or natural origin, and material of a resorbable ornon-resorbable nature. Examples of suitable blocking member materialinclude autograft, allograft or xenograft; tissue materials includingsoft tissues, connective tissues, demineralized bone matrix andcombinations thereof; resorbable materials including polylactide,polyglycolide, tyrosine-derived polycarbonate, polyanhydride,polyorthoester, polyphosphazene, calcium phosphate, hydroxyapatite,bioactive glass, collagen, albumin, fibrinogen and combinations thereof;and non-resorbable materials including polyethylene, polyester,polyvinyl alcohol, polyacrylonitrile, polyamide, polytetrafluorethylene,poly-paraphenylene terephthalamide, cellulose, and combinations thereof.

The anchors can be made from any biocompatible material, includingsynthetic or natural autograft, allograft or xenograft tissues, and canbe resorbable or non-resorbable nature. Examples of tissue materialsinclude hard tissues, connective tissues, demineralized bone matrix andcombinations thereof. Further examples of resorbable materials arepolylactide, polyglycolide, tyrosine-derived polycarbonate,polyanhydride, polyorthoester, polyphosphazene, calcium phosphate,hydroxyapatite, bioactive glass, and combinations thereof. Furtherexamples of non-resorbable materials include high performance polymers,such as polyetheretherketone, carbon-reinforced polymer composites,shape-memory alloys, titanium, titanium alloys, cobalt chrome alloys,stainless steel, and combinations thereof.

The anchors can be solid, porous, semi-porous, fenestrated, cannulated,and combinations thereof to provide strength and bone ingrowth whendesired. The outer surfaces of the anchors can be smooth, roughened,porous, serrated, or combinations thereof to provide the desired pulloutresistance. The anchors can be provided with one or more movablecomponents that resist anchor pullout, such as wings, gulls or flexiblebarbs. It is further contemplated that the anchors can be configured forpositioning into and engagement with the tissue by any one orcombination of rotation force, impaction force, inserted into an openingand thereafter expanded to engage the surrounding tissue, adhesion orbonding, fusion, and tissue ingrowth, for example. The anchors can beprovided in various forms, including screws, tacks, pins, staples,suture anchors, and wedges, for example.

Referring to FIGS. 1 and 2 there is illustrated annulus repair systemaccording to one embodiment. The annulus repair system includes ablocking member 50 and a pair of anchors 70, 80 to secure blockingmember 50 to tissue in the patient. Blocking member 50 includes a body52 extending between a first end 54 and an opposite second end 56.Blocking member 50 includes a length between first end 54 and second end56 sufficient to span the annulus defect between the tissue structure towhich blocking member 50 is to be attached. Body 52 includes a width 68sufficient to extend across at least a portion of the annulus defect toprovide an effective mechanical barrier. In one embodiment, width 68extends across at least 10% of the width of the annulus defect. Inanother embodiment, width 68 extends across at least 50% of the annulusdefect. In another embodiment, body 52 is provided with a width 68 inthe range from about 10% to about 50% of the width of the annulusdefect. In a further embodiment, width 68 extends across substantiallythe entire width of the annulus defect. In still another embodiment,body 52 includes a width 68 that is greater than the width of theannulus defect, and body 52 is compressed laterally to fit within theannulus defect.

First end 54 includes an attachment portion 58 with a passage 60therethrough to receive anchor 70. Second end 56 includes an attachmentportion 62 with a passage 64 therethrough to receive anchor 80. Anchor70 can be provided with a proximal portion 72 and a distal engagementportion 74. Similarly, anchor 80 can be provided with a proximal portion82 and a distal engagement portion 84. Anchors 70, 80 are illustrated inthe form of bone screws with enlarged heads at proximal portions 72, 82and threaded distal engagement portions 74, 84. Proximal portions 72, 82each include a head that abuts against the respective attachment portion58, 62 when positioned through the corresponding passage 60, 64 tosecure blocking member 50 to the tissue structure to which anchors 70,80 are engaged.

In one specific embodiment, attachment portions are in the form ofcircular eyelets made from a suitable bio-compatible metal or polymericmaterial, and provide a rigid body against which the proximal portions72, 82 of anchors 70, 80 abut. In one form, the attachment portions canbe provided with a spherically shaped seat centered about a circularpassage 60, 64 for abutment with spherically shaped surfaces of theheads of anchors 70, 80, permitting multi-axial angular orientations ofanchors 70, 80 relative to attachment portions 58, 62. In another form,attachment portions 58, 62 are configured to engage anchors 70, 80 toprovide a fixed orientation of anchors 70, 80 therethrough. It isfurther contemplated that one attachment portion 58, 62 and itscorresponding anchor 70, 80 provide variable angle anchor placement, andthe other attachment portion 58, 62 and anchor 70, 80 permit fixed angleanchor placement.

Anchors 70, 80 can include a tool engagement opening in the proximal endof proximal portions 72, 82 to facilitate application of a rotationaldriving force, such as is provided with screw driver. Other embodimentscontemplate other forms for anchors 70, 80 as discussed above, includinganchors that are driven into the bony tissue with impaction forces orlinear advancement. It is also contemplated that anchors 70, 80 could beprovided integrally with the respective attachment portions 58, 62. In afurther form, it is contemplated that attachment portions 58, 62 areprovided without a passage, and anchors 70, 80 penetrate attachmentportions 58, 62. In still a further form, anchors 70, 80 penetrate body52 to engage blocking member 50 to the adjacent tissue.

Referring now further to FIGS. 3 and 4, there is shown a spinal columnsegment 100 including a first vertebra 102, a second vertebra 104, and aspinal disc space 106 therebetween. Spinal disc space 106 includesannulus 108 extending therearound. Annulus 108 includes a defect 110formed therein. Defect 110 can be created or formed for any one orcombination of reasons, including an annulotomy, a discectomy,nucleotomy, implantation of artificial disc nucleus or artificial discprosthesis, repair of a disc herniation, or rip, tear or otherdegeneration or condition associated with the annulus. It iscontemplated that the annulus repair systems can be positioned in adefect at any location about vertebrae 102, 104, including the anterior,antero-lateral, oblique, lateral, posterior-lateral or posteriorportions of vertebrae 102, 104.

It is contemplated that an implant 112 can be positioned in spinal discspace 106 between vertebrae 102, 104 through defect 110. Implant 112 canbe one or more interbody spacers, fusion implants, artificial discs,artificial nucleus, or any other device suitable for placement betweenvertebrae. It is further contemplated that implant 112 not be providedin spinal disc space 106.

In FIGS. 5 and 6, hole 114 is formed in vertebra 102, and hole 116 isformed in vertebra 104. Holes 114, 116 are aligned across defect 110. Inthe illustrated embodiment, holes 114, 116 are spaced from the endplateof the respective vertebra 102, 104 so that blocking member 50 canextend along the entire height of the defect between vertebrae 102, 104.In FIGS. 7 and 8, recess 118 is formed in vertebra 102 and extends fromthe endplate of vertebra 102 to hole 114. Recess 120 is formed invertebra 104 and extends between the endplate of vertebra 104 and hole116. Recesses 118, 120 communicate with defect 110, and extend in thegeneral direction of central axis 130 of the spinal column to receiveblocking member 50 in a corresponding orientation. It is furthercontemplated that recesses 118, 120 can extend transversely to centralaxis 130 with recesses 118, 120 communicating with holes 114, 116 anddefect 110.

In FIGS. 9 and 10, blocking member 50 is positioned with body 52 indefect 110 and in recesses 118, 120. Attachment portion 58 is positionedin hole 114, and attachment portion 62 is positioned in hole 116. Anchor70 extends through attachment portion 58, and secures blocking member 50in hole 114 and recess 118. Anchor 80 extends through attachment portion62, and secures blocking member 50 in hole 116 and recess 120.

In the secured position, body 52 of blocking member 50 is offset from anouter surface 109 of annulus 108 toward disc space 106. This permitsblocking member 50 to block implant 112 and/or nucleus material in discspace 106 before it exits defect 110. The recessed blocking member 50further facilitates attachment of an exterior stabilization device, suchas a spinal plate, along the outer surface 109 of annulus 108 and theouter surfaces of vertebrae 102, 104 without interference from blockingmember 50 or anchors 70, 80. In addition, blocking member 50 provides aneffective mechanical barrier, while annulus tissue at defect 110 ispermitted to grow and/or repair without being subject to stresses thatmight result from the implant and/or nucleus material attempting toexpel through defect 110. Blocking member 50 can also restrain motion ofthe spinal column segment by limiting separation of vertebrae 102, 104.

Referring to FIGS. 11 and 12 there is illustrated another embodimentannulus repair system. The annulus repair system includes a blockingmember 150 and a pair of anchors 170, 180 to secure blocking member 150to tissue in the patient. Blocking member 150 includes a body 152extending between a first end 154 and an opposite second end 156.Blocking member 150 includes a length between first end 154 and secondend 156 sufficient to span the annulus defect between the tissuestructure to which blocking member 150 is to be attached. Body 152includes a width 168 sufficient to extend across at least a portion ofthe annulus defect to provide an effective mechanical barrier asdiscussed above with respect to blocking member 50.

First end 154 includes an attachment portion 158 with a passage 160therethrough to receive anchor 170. Second end 156 includes anattachment portion 162 with a passage 164 therethrough to receive anchor180. Anchor 170 can be provided with a proximal portion 172 and a distalengagement portion 174. Similarly, anchor 180 can be provided with aproximal portion 182 and a distal engagement portion 184. Proximalportions 172, 182 each include an enlarged head that abuts against therespective attachment portion 158, 162 when positioned through thecorresponding passage 160, 164 to secure blocking member 150 to thetissue structure to which anchors 170, 180 are engaged.

Anchors 170, 180 are illustrated in the form of bone interferencedevices with elongated with engaging surfaces 176, 186 formed alongdistal engagement portions 174, 184. Anchor 170 includes a width 179,and anchor 180 includes a width 189. Widths 179, 189 provide a surfacearea along and across engagement portions 174, 184 for engagement withthe adjacent tissue. Engaging surfaces 176, 186 include ridges andvalley between adjacent ridges that extend transversely to the insertiondirection of anchors 170, 180. A pointed distal end 178, 188 facilitatespenetration of anchor 170, 180 into bony tissue. Anchors 170, 180 can beinserted by applying an impact force to proximal portions 172, 182 thatdrives engagement portions 174, 184 into the bony tissue.

In one specific embodiment, attachment portions 158, 162 are in the formof oval-shaped or elongated eyelets made from a suitable bio-compatiblemetal or polymeric material, and provide a rigid body against which theproximal portions 172, 182 of anchors 170, 180 abut. Other embodimentscontemplate other forms for anchors 170, 180 as discussed above. It isalso contemplated that multiple anchors could be positioned along thewidth of passage 160, 164. In a further form, it is contemplated thatattachment portions 158, 162 are provided without a passage, and anchors170, 180 penetrate attachment portions 158, 162 or body 152 of blockingmember 150.

Widths 179, 189 of anchors 170, 180 can be greater than width 168 ofbody 152 of blocking member 150. In one specific embodiment, widths 179,189 are each at least twice as great as width 168, providing anchors170, 180 with greater surface area to engage the adjacent bony tissueand resist pullout forces that may be applied to blocking member 50.Other embodiments contemplate widths 179, 189 for anchors 170, 180 thatare less than twice the width 168 of blocking member 150, or less thanwidth 168 of blocking member 152.

In FIGS. 13 and 14, hole 122 is formed in vertebra 102, and hole 124 isformed in vertebra 104. Holes 122, 124 are aligned with defect 110. Inthe illustrated embodiment, holes 122, 124 are spaced from the endplateof the respective vertebra 102, 104 so that blocking member 150 canextend along defect 110 between vertebrae 102, 104. Holes 122, 124 areelongated and extend transversely to the central axis 130 of the spinalcolumn axis to receive anchors 170, 180 in corresponding orientationrelative to central axis 130. Holes 122, 124 are each provided with awidth sized to accommodate the attachment portion 158, 162 and anchor170, 180 to be positioned therein.

In FIGS. 15 and 16, recess 126 is formed in vertebra 102 and extendsfrom the endplate of vertebra 102 to hole 122. Recess 128 is formed invertebra 104 and extends between the endplate of vertebra 104 and hole124. Recesses 126, 128 provide communication for holes 124, 126 withdefect 110.

In FIGS. 16 and 17, blocking member 150 is positioned with body 152 indefect 110 and in recesses 126, 128. Attachment portion 158 ispositioned in hole 122, and attachment portion 162 is positioned in hole124. Anchor 170 extends through attachment portion 158, and securesblocking member 150 in hole 122 and recess 126. Anchor 180 extendsthrough attachment portion 162, and secures blocking member 150 in hole124 and recess 128.

Referring to FIGS. 19-21, there is shown one embodiment instrument forforming recesses 118, 120 or recesses 126, 128 in the vertebrae 102,104. Cutting instrument 200 includes an elongated shaft 202 and acutting blade 204 at a distal end of shaft 202. Blade 204 includes abody 206 that includes a distal cutting end 208. Body 206 includes awidth 210 that corresponds to the width of the recess to be formed.Cutting end 208 includes a sharp edge to facilitate penetration intobony tissue, and is tapered distally from a width 210 to facilitateformation of the recess. Shaft 202 includes a distally opening slot 212to receive a proximal portion of body 206 therein for attachmentthereto. Blade 204 projects distally from the distal end of shaft 202 asufficient distance to form a recess of desired depth into the vertebra.Blade 204 further projects along one side of shaft 202 to facilitateformation of a recess in the vertebra that includes a desired lengthalong the central axis of the spinal column.

FIG. 22 shows one embodiment of an instrument for forming holes 114, 116in the vertebrae. Drill 220 includes a shaft 222 and a distal cuttingtip 224 in the form of a drill bit. Cutting tip 224 can form circularholes in the vertebra upon application of a rotary force thereto. Holes122, 124 can be formed by drilling a plurality of overlapping holes withdrill 220, or by moving drill 220 laterally along a suitable guide.Other bone cutting or removal instruments are also contemplated forforming recesses 118, 120, 126, 128 and/or holes 114, 116, 122, 124,including burrs, mills, chisels, and scrapers, for example.

FIGS. 23 and 24 provide an example of a guide instrument 250 that can beused in the formation of, for example, hole 114 and the recess 118 incommunication therewith in vertebrae 102, or hole 116 and recess 120 invertebra 104. It is still further contemplated that guide 250 can beadapted to guide formation of holes 122, 124 and recesses 126, 128 incommunication therewith. Guide instrument 250 can be used to guide drill220 and cutting instrument 200 to the proper locations on vertebrae 102,104 relative to defect 110.

In the illustrated embodiment, guide instrument 250 includes a handleassembly 252 attachable to a guide assembly 254. Guide assembly 254extends along longitudinal axis 251 and includes a proximal portion 256and a distal portion 258. Distal portion 258 is positionable inside thepatient, with at least a portion of proximal portion 256 accessible bythe surgeon. Proximal portion 256 includes a shaft 259 having a numberof engagement holes 262 formed therein. Handle assembly 252 include ahandle member 264 with a slotted end 266 adapted to receive shaft 259.An engaging member 268 in the form of a pin or the like is positionablethrough passages 270 of handle member 264 for engagement with an alignedengagement hole 262 extending through shaft 259. The number ofengagement holes 262 provide to the surgeon the ability to adjust thelength of guide instrument 250 extending distally from handle assembly252.

Distal portion 258 includes an elongated guide member 272 extendingalong longitudinal axis 251 of guide instrument 250. Guide member 272includes a passage 274 extending therethrough along longitudinal axis251. A slot 276 extends through a wall of guide member 272 and is incommunication with passage 274. Passage 274 and slot 276 open at distalend 259 of distal portion 258. Passage 274 and slot 276 further extendalong shaft 259 of proximal portion 256 to receive instrumentstherethrough from proximal end 260 of shaft 259.

Distal portion 258 further includes a positioning member 278 along adistal portion of guide member 272. Positioning member 278 includes abody portion 280 secured to guide member 272. Body portion 280 includesa slot 284 therethrough aligned with slot 276 of guide member 272. Apositioning flange 282 extends distally from body portion 280, andprojects distally beyond distal end 259. Positioning flange 282 is sizedfor positioning in the annulus defect in contact with adjacent vertebralplate with distal end 259 of guide member 272 in contact with oradjacent to vertebra 102, 104 in which it is desired to form a hole andrecess.

It is contemplated that passage 274 can be circular to guide placementof a drill bit for forming a circular hole, such as holes 114, 116. Itis further contemplated that passage 274 can be oval in shape to guideformation of elongated holes, such as discussed above with respect toholes 122, 124. It is further contemplated that guide member can beprovided with a reduced cross-sectional size to facilitate positioningthrough a minimally invasive access portal, such as a sleeve, cannula,split-tube retractor, a retractor blade, or micro-incision, for example.

In use, distal portion 258 is positioned through an incision, tube orother access portal to the annulus defect. Positioning flange 282 ofpositioning member 278 is placed into the annulus defect and in contactwith the vertebral endplate of a vertebra in which it is desired to forma hole and recess. A drilling instrument, such as drill 220, is guidedto the vertebra through passage 274 of guide member 272 to form a holein the vertebra. After formation of the hole, the drilling instrument isremoved, and a cutting instrument, such as cutting instrument 200, isguided through passage 274 with its blade projecting through slot 276while shaft 202 if cutting instrument 200 is guided in passage 274. Thecutting blade is advanced into the vertebral body to form the recess incommunication with and extending between the formed hole and the defect.Guide instrument 250 is then removed, and a hole and recess are formedin the other vertebral body in communication with the annulus defect.

The guide instrument is then removed, and an annulus repair system ispositioned in the prepared recesses and holes and secured thereto withanchors. The bony tissue along the sides of the recesses laterallyrestrains the blocking member to resist it moving laterally relative tothe defect, which could enlarge the unblocked portion of the defect.Anchors engaged to ends of the blocking member provide axial constraintfor the blocking member, and maintain the blocking member in therecesses.

While embodiments of the invention have been illustrated and describedin detail in the drawings and foregoing description, the same is to beconsidered as illustrative and not restrictive in character, it beingunderstood that all changes and modifications that come within thespirit of the invention are desired to be protected.

1. A system for repairing a defect in an annulus of a spinal disc,comprising: at least one blocking member positionable at least adjacentto the defect in the annulus; at least one anchor engageable with saidat least one blocking member to secure said blocking member to tissueadjacent the defect; and a guide instrument including distal portionpositionable in the defect, said guide instrument including a guidemember adapted to guide an instrument for forming a hole in the tissueto receive the at least one anchor, said guide member being furtheradapted to guide a cutting instrument for forming a recess in the tissueextending between the hole and the defect.
 2. The system of claim 1,wherein said blocking member includes an attachment portion extendingfrom one end thereof, said attachment portion being adapted to receivesaid at least one anchor therethrough.
 3. The system of claim 2, whereinsaid attachment portion includes an eyelet defining a passagetherethrough for receiving said at least one anchor.
 4. The system ofclaim 2, wherein said blocking member includes an attachment portion atthe other end thereof, and further comprising a second anchor receivablethrough said second attachment portion.
 5. The system of claim 2,wherein said attachment portion includes an elongated passage extendingtransversely to said blocking member.
 6. The system of claim 5, whereinsaid at least one anchor comprises a body sized and shaped forform-fitting receipt in said elongated passage.
 7. The system of claim6, wherein said body of said at least one anchor includes a proximalportion and a distal engagement portion, said distal engagement portionincluding a number of ridges and valleys extending thereacross.
 8. Thesystem of claim 5, wherein said body of said at least one anchorincludes a generally rectangular cross-section and planar upper andlower surfaces.
 9. The system of claim 1, wherein said blocking memberincludes a width along the annulus when positioned in the defect that isless than a width of the defect along the annulus.
 10. The system ofclaim 1, wherein said at least one anchor includes means for resistingpullout from the tissue.
 11. The system of claim 1, wherein saidblocking member is made from a resorbable material selected from thegroup consisting of: autograft, allograft, xenograft, hard tissue,connective tissue, demineralized bone matrix, polylactide,polyglycolide, tyrosine-derived polycarbonate, polyanhydride,polyorthoester, polyphosphazene, calcium phosphate, hydroxyapatite,bioactive glass, collagen, albumin, fibrinogen and combinations thereof.12. The system of claim 1, wherein said blocking member is made from anon-resorbable material selected from the group consisting of:polyethylene, polyester, polyvinyl alcohol, polyacrylonitrile,polyamide, polytetrafluorethylene, poly-paraphenylene terephthalamide,cellulose, and combinations thereof.
 13. The system of claim 1, whereinsaid blocking member and said at least one anchor each compriseresorbable material.
 14. The system of claim 1, wherein said blockingmember and said at least one anchor each comprise non-resorbablematerial.
 15. The system of claim 1, wherein the defect has a widthalong the annulus and said blocking member extends across at least about10% of the width of the defect when positioned therein.
 16. The systemof claim 1, wherein the defect has a width along the annulus and saidblocking member extends across about 10% to about 50% of the width ofthe defect when positioned therein.
 17. The system of claim 1, whereinthe defect has a width along the annulus and said blocking memberextends across at least about 50% of the width of the defect whenpositioned therein.
 18. The system of claim 1, wherein said blockingmember includes a body portion including one or more components selectedfrom the group consisting of: woven tubing, sutures, tethers, cords,planar members, bands, wires, cables, mesh sheets, braids, plugs, andscaffolds.
 19. The system of claim 1, wherein said guide member of saidguide instrument is elongated and includes a passage extendingtherethrough for receiving the instrument for forming the hole and aslot extending through said body in communication with said passage forreceiving the instrument for forming the recess.
 20. The system of claim19, wherein said guide instrument member further comprises a positioningflange extending distally from said guide member and offset from saidpassage.
 21. The system of claim 20, wherein said positioning flangecomprises a portion of a positioning member, said positioning memberincluding a body mounted to said guide member, said positioning flangeextending distally from said body.
 22. The system of claim 20, whereinsaid body includes a slot therethrough aligned with and in communicationwith said slot of said guide member.
 23. The system of claim 19, furthercomprising a shaft extending proximally from said guide member and ahandle assembly extending from said shaft.
 24. The system of claim 23,wherein said handle assembly includes a handle member orientedtransversely to a longitudinal axis of said guide instrument.
 25. Thesystem of claim 24, wherein said handle member is securable at aplurality of locations along said shaft to adjust a length of said guideinstrument extending distally from said handle member.
 26. The system ofclaim 23, wherein said slot and said passage extend through said shaft.27. The system of claim 19, wherein said instrument for forming the holecomprises a drill instrument positionable through said passage andoperable therethrough to form the hole.
 28. The system of claim 19,wherein said cutting instrument includes an elongated shaft positionablein said passage, said cutting instrument further comprising a bladeextending from said shaft through said slot and movable along said slotwith movement of said shaft along said passage.
 29. The system of claim28, wherein said blade includes a sharpened distal end spaced distallyfrom a distal end of said elongated shaft.
 30. A method for repairing anannulus defect of a spinal disc, comprising: forming a recess in avertebra on at least one side of the spinal disc in communication withthe defect; positioning a blocking member in the defect and into therecess; and engaging the blocking member to the vertebra.
 31. The methodof claim 30, further comprising: forming a hole in the vertebra incommunication with the defect through the recess; and engaging theblocking member to the vertebra with an anchor extending through theblocking member and into the hole.
 32. The method of claim 31, whereinforming the hole includes forming a circular hole.
 33. The method ofclaim 31, wherein forming the hole includes forming a hole elongatedtransversely to the central axis of the spinal column.
 34. The method ofclaim 30, wherein positioning the blocking member in the defect includespositioning the blocking member in the defect in a location recessedfrom an outer surface of the annulus.
 35. The method of claim 30,wherein forming the recess includes placing a distal portion of a guidemember in the defect in contact with an endplate of the vertebra andguiding a cutting instrument with the guide member to form the recessfrom the endplate into the vertebra along the central axis of the spinalcolumn.
 36. The method of claim 35, wherein forming the recess includesplacing the distal portion of the guide member in the defect in contactwith an endplate of a second vertebra on the other side of the spinaldisc and guiding the cutting instrument with the guide member to form asecond recess from the endplate of the second vertebra along the centralaxis of the spinal column.
 37. The method of claim 36, furthercomprising: guiding a drilling instrument with the guide member to forma hole in the vertebra spaced from the endplate of the vertebra, thehole being in communication with the recess at an end thereof; andguiding the drilling instrument with the guide member to form a secondhole in the second vertebra spaced from the endplate of the secondvertebra, the second hole being in communication with the second recessat an end thereof.
 38. The method of claim 30, further comprisingforming a hole in the vertebra in communication with the recess.
 39. Themethod of claim 38, wherein the hole is formed at an end of the recessremote from the defect.
 40. The method of claim 38, further comprising:positioning an attachment portion of the blocking member in the hole;and positioning an anchor through the attachment portion and into thehole to engage the blocking member to the vertebra.
 41. The method ofclaim 40, wherein the blocking member, attachment portion and anchor arerecessed below an outer surface of the vertebra.
 42. The method of claim30, further comprising: forming a second recess in communication withthe defect in a second vertebra on the other side of the spinal disc;positioning the blocking member into the second recess; and engaging theblocking member to the second vertebra.
 43. The method of claim 42,further comprising: forming a first hole in the vertebra incommunication with the defect through the recess; forming a second holein the second vertebra in communication with the defect through thesecond recess; engaging the blocking member to the vertebra with a firstanchor extending through the blocking member and into the first hole;and engaging the blocking member to the second vertebra with a secondanchor extending through the blocking member and into the second hole.44. The method of claim 43, further comprising: positioning a firstattachment portion of the blocking member in the first hole; positioningthe first anchor through the first attachment portion and into the firsthole to engage the blocking member to the vertebra; positioning a secondattachment portion of the blocking member in the second hole; andpositioning the second anchor through the second attachment portion andinto the second hole to engage the blocking member to the secondvertebra.
 45. The method of claim 44, wherein the blocking member, thefirst and second attachment portions and the first and second anchorsare recessed below an outer surface of the vertebrae.
 46. The method ofclaim 30, wherein the recess opens along an outer surface of thevertebra.
 47. A method for repairing an annulus defect in a spinal disc,comprising: positioning a flexible blocking member in the annulusdefect; and laterally restraining the flexible blocking member with bonytissue of a vertebra on at least one side of the spinal disc.
 48. Themethod of claim 47, further comprising: forming a recess in the vertebrain communication with the defect; and positioning the blocking member inthe recess.
 49. The method of claim 48, wherein the recess opens alongan outer surface of the vertebra.
 50. The method of claim 48, furthercomprising axially constraining the flexible blocking member with atleast one anchor engaged with the vertebra.
 51. The method of claim 47,further comprising laterally restraining the flexible blocking memberwith bony tissue of a second vertebra on the other side of the spinaldisc.
 52. The method of claim 51, further comprising axiallyconstraining the flexible blocking member with an anchor at each end ofthe flexible blocking member engaged with the adjacent vertebra.
 53. Themethod of claim 52, further comprising recessing each anchor in a holeformed in an outer surface of each vertebra.
 54. The method of claim 53,wherein each hole is in communication with a recess formed in theadjacent vertebra, each recess extending between the adjacent hole andthe annulus defect.
 55. An instrument for guiding preparation of a bonysurface to receive an implant, comprising: a guide member extendingalong a longitudinal axis, said guide member including a passageextending therethrough along the longitudinal axis for guiding a firstinstrument to form a hole in the bony surface, said guide member furtherincluding a slot extending along said passage and in communicationtherewith for guiding a cutting instrument to form a recess in the bonysurface.
 56. The instrument of claim 55, further comprising apositioning member extending along a side of said guide member, saidpositioning member including a positioning flange extending distally ofsaid guide member, said positioning flange positionable along a bonystructure to facilitate formation of the hole and recess in the bonysurface.
 57. The instrument of claim 56, wherein said positioning memberincludes a body extending from said guide member and said positioningflange is spaced from said guide member and extends distally from saidbody.
 58. The instrument of claim 57, wherein said body includes a slotin communication with said slot of said guide member.
 59. The instrumentof claim 56, wherein said positioning flange is offset from said guidemember toward a side thereof including said slot.
 60. The instrument ofclaim 55, wherein said guide member includes a proximal shaft and saidpassage and said slot extend through said shaft.
 61. The instrument ofclaim 60, further comprising a handle assembly adjustably attached tosaid shaft.
 62. The instrument of claim 55, wherein said passage iscircular in a cross-section orthogonal to the longitudinal axis.
 63. Theinstrument of claim 55, wherein said passage is elongated in across-section orthogonal to the longitudinal axis.
 64. A device forrepairing an annulus defect, comprising: a blocking member extendingalong a longitudinal axis between a first end and a second end; and anattachment portion at one of said first and second ends, said attachmentportion including an elongated passage extending transversely to thelongitudinal axis of said blocking member.
 65. The device of claim 64,further comprising a second attachment portion at the other of saidfirst and second ends, said second attachment portion including anelongated passage extending transversely to the longitudinal axis ofsaid blocking member.
 66. The device of claim 64, further comprising ananchor positionable through said passage to secure said blocking memberto tissue.
 67. The device of claim 66, wherein said anchor includes abody having a length extending between a proximal end and a distal end,said body including a width between said proximal and distal ends sizedfor form-fitting receipt in said elongated passage.
 68. The device ofclaim 67, wherein said body of said anchor includes first and secondsurfaces along said width, said first and second surfaces including boneengagement features thereon.
 69. The device of claim 68, wherein saidbone engagement features include a plurality of ridges and valleys alongeach of said first and second surfaces.
 70. A device for repairing anannulus defect, comprising: a blocking member extending along alongitudinal axis between a first end and a second end, said blockingmember including a width transverse to the longitudinal axis; and atleast one anchor positionable through said blocking member to engagesaid blocking member to tissue adjacent the annulus defect, said atleast one anchor comprising a body including a width, wherein in anengagement orientation with said blocking member said width of saidblocking member is at least twice as great as said width of saidblocking member.
 71. The device of claims 70, wherein said blockingmember includes an attachment portion at one of said first and secondends, said attachment portion including an elongated passage extendingtransversely to the longitudinal axis of said blocking member, saidanchor being positionable through said passage to engage said blockingmember to adjacent tissue.
 72. The device of claim 70, wherein said bodyof said anchor includes first and second surfaces along said width, saidfirst and second surfaces including bone engagement features thereon.